[A case of unicentric chest wall Castleman disease-associated paraneoplastic autoimmune multiorgan syndrome]

This article reported on a case of unicentric chest wall Castleman disease, diagnosed by surgical pathology, which manifested primarily as oral mucosal erosions and bronchiolitis obliterans. The patient, a 25-year-old male, was admitted to the hospital on December 18, 2023, with an 11-month history of oral mucosal erosions and an 8-month history of dyspnea with reduced exercise tolerance. Pulmonary function tests revealed extremely severe obstructive ventilatory dysfunction with a negative bronchodilator response. Chest computed tomography (CT) scan showed a soft-tissue mass in the deep muscle layer of the left chest wall with enhancement. PET/CT demonstrated slightly increased metabolic activity at this site, with a maximum standardized uptake value (SUVmax) of 2.1. Additionally, the patient tested positive for BP-180 pemphigoid antibody. Taken together, the constellation of these findings could be explained by a unifying diagnosis, with histopathological confirmation being key. Surgical pathology of the chest wall mass confirmed the diagnosis of Castleman disease (hyaline vascular type). Ultimately, the patient was diagnosed with unicentric chest wall Castleman disease-associated paraneoplastic autoimmune multiorgan syndrome and successfully underwent bilateral lung transplantation approximately one year after diagnosis.